New trends in breast cancer surgery: a therapeutic approach increasingly efficacy and respectful of the patient

Abstract

The surgical management of breast cancer has undergone continuous and profound changes over the last 40 years. The evolution from aggressive and mutilating treatment to conservative approach has been long, but constant, despite the controversies that appeared every time a new procedure came to light. Today, the aesthetic satisfaction of breast cancer patients coupled with the oncological safety is the goal of the modern breast surgeon. Breast-conserving surgery with adjuvant radiotherapy is considered the gold standard approach for patients with early stage breast cancer and the recent introduction of "oncoplastic techniques" has furtherly increased the use of breast-conserving procedures. Mastectomy remains a valid surgical alternative in selected cases and is usually associated with immediate reconstructive procedures. New surgical procedures called "conservative mastectomies" are emerging as techniques that combine oncological safety and cosmesis by entirely removing the breast parenchyma sparing the breast skin and nipple-areola complex. Staging of the axilla has also gradually evolved toward less aggressive approaches with the adoption of sentinel node biopsy and new therapeutic strategies are emerging in patients with a pathological positivity in sentinel lymph node biopsy. The present work will highlight the new surgical treatment options increasingly efficacy and respectful of breast cancer patients.

Fig. 1

Oncoplastic technique of reduction mammaplasty: postoperative view at 7 months.

Fig. 2

Skin incisions in conservative oncoplastic surgery: a) in the donut mastopexy, two concentric circles of different diameter are designed around the nipple; b) in the batwing mastopexy, two half-circle are designed and connected with angled wings on each side of the areola; c) in the Grisotti procedure, two circles are drawn, one along the borders of the areola, the other below the areola and lines from the medial and lateral sides of the areolar circle are connected down and laterally on the inframammary fold; d) in the reduction mammaplasty, a key-hole pattern incision may be used.

Fig. 3

A bilateral nipple-sparing mastectomy and immediate reconstruction with a definitive anatomical prosthesis.